What is an atrophic pancreas?
Atrophic pancreas is a condition in which the pancreas decreases in size and/or volume. It is associated with a reduction of pancreatic endocrine and exocrine functions [1, 2, 3].
The exocrine function of the pancreas is to produce digestive enzymes, which are necessary to break down the rest of the food in the stomach [1, 2].
The pancreas produces several enzymes, including pancreatic amylase, trypsin, lipase [4], elastase, carboxypeptidase [5], phospholipase A, ribonuclease [6], deoxyribonuclease [7], and cholesterol esterase [8].
The pancreas's endocrine function is to regulate the sugar level in the blood and the digestive system. To regulate the glucose levels in the blood, the pancreas produces insulin [3] and glucagon [9].
The production of somatostatin, pancreatic polypeptide, and ghrelin aides in regulating digestive functions [10].
The decrease in function of the atrophic pancreas can lead to malnutrition, weight loss [2], insulin deficiency, and pancreatic diabetes [2, 3].
What are the causes of the atrophic pancreas?
The primary cause of the atrophic pancreas is chronic pancreatitis. It is a prolonged inflammation of the pancreas that leads to damage and atrophy of the organ [11, 2].
Also, acute pancreatitis can cause the pancreas to atrophy, particularly when the inflammation is repeated [2].
Pancreatic atrophy can also occur in type 1 diabetes [3], as well as after pancreatic surgeries like pancreatoduodenectomy [12]. Also, people with cystic fibrosis can develop pancreatic atrophy [13]. It can also be an early sign of pancreatic cancer [14].
What are the symptoms of an atrophic pancreas?
When you have an atrophic pancreas, you can experience symptoms such as:
- progressive and persistent abdominal pain [15],
- nausea and vomiting, especially after eating [16, 17],
- unintentional weight loss [18],
- loss of appetite, and anorexia [19, 17],
- jaundice [20],
- fatigue [20].
In severe cases, patients may also have shortness of breath and excessive thirst [17].
What is the diagnosis and treatment of atrophic pancreas?
Imaging findings are an important diagnostic criterion for atrophic pancreas. To diagnose the atrophy of the pancreas, doctors have to use imaginative methods like MRI, CT, or Endoscopic ultrasonography (EUS) [21].
They can be linked to symptoms or a patient's history of present or past diseases. However, sometimes, an atrophic pancreas can have no symptoms. Thus, it will only be diagnosed based on the image result.
The treatment of the atrophic pancreas depends on the underlying cause [22].
In cases of acute pancreatitis, fluid replacement, fasting, and painkillers are essential therapies [22].
Alcohol cessation, painkillers, a special diet, and pancreatic enzyme supplementation treat chronic pancreatitis. In complex cases, surgical interventions can also be an option [23].
What is the life expectancy with an atrophic pancreas?
Similar to the treatment, the life expectancy with an atrophic pancreas depends on the cause of the condition.
For example, the average survival time for pancreatic cancer was 1.4 years [24]. However, if the cancer tumor that causes the atrophy is a less common pancreatic neuroendocrine tumor, the expectancy is better. The mean survival in this case ranges from 5.5 years to 7.8 years [25].
In a situation when the cause of atrophic pancreas is chronic pancreatitis, the survival rate at ten years is reported to be 70% [26].